新生儿重症监护室多重耐药菌种类及药敏结果临床意义评估

目的探讨新生儿重症监护室（NICU）多重耐药菌的种类并评估多重耐药菌药敏试验的结果在临床选用抗生素的意义,以指导临床合理用药。方法对我院NICU2010年1月-2010年12月60例新生儿下呼吸道痰培养结果为多重耐药菌的病例进行分析。观察多重耐药菌种类,对耐药菌根据患儿的临床症状、胸片、血常规、CRP、I/T值、血沉等结果综合评估患儿是否需要更改抗生素,更改为未更改抗生素组和更改抗生素组,比较两组的住院时间、住院费用、插管时间及肝肾功能损害。结果新生儿重症监护室多重耐药菌以肺炎克雷伯菌、鲍曼不动杆菌、表皮葡萄球菌、大肠埃希菌、铜绿假单胞菌为主。更改抗生素组与未更改抗生素组的住院时间、住院费用、插管时间无统计学意义。肝肾功能损害,P〈0.05,差异有统计学意义。结论多重耐药菌呈增多趋势,大肠埃希菌、肺炎克雷伯菌、肠杆菌耐药率在65%以上。对耐药菌的抗生素选用,不能完全根据药敏结果来选药。应根据患儿临床表现及其他实验结果综合评估,以达到给患儿最好治疗效果及愈后。     

血清胆红素水平与胆红素脑病MRI表现的相关性分析

【目的】探讨MRI信号改变与高胆红素血症的严重程度的相关性,为胆红素脑病的早期诊断提供客观依据。【方法】432例重度高胆红素血症新生儿[血清总胆红素（TSB）≥342μmol／L）]在黄疸高峰期后接受头部MRI检查,根据TSB峰值将高胆红素血症患儿分为轻度组（342～427．5μmol／L）,中度组（427．5～513μmol／L）和重度组（≥513μmol／L）,分析MRI T1WI苍白球高信号阳性率与TSB水平的关系,并进行统计学分析。【结果】432例重度高胆红素血症患儿中338例苍白球T1WI呈对称性高信号改变（78．2％）,重度组阳性率最高（94．4％,34／36）,中度组和轻度组阳性率分别为80．5％（95／118）,75．2％（209／278）,黄疸程度与苍白球信号改变有密切关系（X2=7．438,P=0．024）;早期新生儿组苍白球信号改变（82．5％,222／269）明显高于晚期新生儿组（71．2%,116／163）,差异有统计学意义（X2=7．697,P〈0．01）。【结论】MRI T1WI苍白球对称性高信号与高胆红素血症的严重程度及日龄密切相关,是新生儿急性胆红素脑病的重要表现特征。     

新生期大鼠反复惊厥上调大脑皮质可塑性相关基因-1蛋白水平

Objective To explore the dynamic expression of a new phospholipid phosphatase, plasticity related gene 1 ( PRG-1 ) in cerebral cortex following recurrent neonatal seizures.Methods A seizure was induced by inhalant flurothyl daily in neonatal Sprague-Dawley rats from postnatal day 6 (P6).Rats were assigned into the recurrent-seizure group (seizures induced in six consecutive days) and the control group.At 3 h,12 h,48 h,14d after the last convulsion,PRG-1 protein level in cerebral cortex was detected by western blot method.Results At 3 h, 12 h,48 h, 14d after the last convulsion in control group, the expression of PRG-1 in cerebral cortex respectively was 1.363 ± 0.742,1.278 ± 0.687 ,0.763 ± 0.374,1.004 ± 0.113, in experimental group , the expression of PRG-1 in cerebral cortex respectively was 1.818 ± 1.093,1.562 ± 0.782,1.024 ± 0.510,1.378 ± 0.279.At 3 h, 12 h,48 h, the expression of PRG-1 in cerebral cortex was not significantly different between the experimental and control group( t = 0.843,0.668,1.011 ,all P ＞ 0.05 ).However, at 14 d, the level of PRG-1 protein in cerebral cortex of experimental group was significantly higher than that of control ( t = 3.041, P ＜ 0.05 ).Conclusion The up-regulated expression of PRG-1 in cerebral cortex may be associated with the recurrent neonatal seizure-induced brain damage.     

可塑性相关基因-1在反复惊厥新生大鼠大脑皮质中的动态表达

目的探讨可塑性相关基因-1(PRG-1)在反复惊厥新生大鼠大脑皮质中的动态表达。方法出生6d(P6)的SD大鼠48只随机分成2组,每组各24只。实验组在P6时吸入三氟乙醚诱导惊厥发作,持续30min,连续6d;对照组同样操作但不吸入三氟乙醚。于最后1次惊厥1.5h、6.0h、24.0h、7d,取其大脑皮质,并在每个时间点设未行任何干预的对照组。用免疫印迹方法检测各组新生大鼠大脑皮质中PRG-1蛋白的表达。采用SPSS17.0软件进行统计学处理。结果对照组新生大鼠4个时间点间大脑皮质PRG-1的表达无统计学差异(F=2.044,P=0.140),实验组各时间点之间大脑皮质PRG-1的表达亦无统计学差异(F=2.483,P=0.090)。1.5h、6.0h、24.0h3个时间点实验组新生大鼠大脑皮质PRG-1的表达与对照组比较均无统计学差异(t=0.295、0.627、0.934,Pa>0.05)。7d时,实验组大脑皮质PRG-1表达明显高于对照组(t=2.347,P=0.041)。结论PRG-1在新生大鼠反复长程惊厥后的远期表达增多,可能参与发育期惊厥性脑损伤的病理生理机制。     

新生期大鼠反复惊厥上调大脑皮质可塑性相关基因-1蛋白水平

Objective To explore the dynamic expression of a new phospholipid phosphatase, plasticity related gene 1 ( PRG-1 ) in cerebral cortex following recurrent neonatal seizures.Methods A seizure was induced by inhalant flurothyl daily in neonatal Sprague-Dawley rats from postnatal day 6 (P6).Rats were assigned into the recurrent-seizure group (seizures induced in six consecutive days) and the control group.At 3 h,12 h,48 h,14d after the last convulsion,PRG-1 protein level in cerebral cortex was detected by western blot method.Results At 3 h, 12 h,48 h, 14d after the last convulsion in control group, the expression of PRG-1 in cerebral cortex respectively was 1.363 ± 0.742,1.278 ± 0.687 ,0.763 ± 0.374,1.004 ± 0.113, in experimental group , the expression of PRG-1 in cerebral cortex respectively was 1.818 ± 1.093,1.562 ± 0.782,1.024 ± 0.510,1.378 ± 0.279.At 3 h, 12 h,48 h, the expression of PRG-1 in cerebral cortex was not significantly different between the experimental and control group( t = 0.843,0.668,1.011 ,all P ＞ 0.05 ).However, at 14 d, the level of PRG-1 protein in cerebral cortex of experimental group was significantly higher than that of control ( t = 3.041, P ＜ 0.05 ).Conclusion The up-regulated expression of PRG-1 in cerebral cortex may be associated with the recurrent neonatal seizure-induced brain damage.     

新生期大鼠反复惊厥上调大脑皮质可塑性相关基因-1蛋白水平

目的 探索可塑性相关基因-1(plasticity related gene 1,PRG-1)在反复惊厥大鼠大脑皮质中的动态表达及其意义.方法 用三氟乙醚使新生第6天的SD大鼠呈现反复惊厥状态,每天持续30min,连续6d,分别于末次惊厥后3h,12h,48 h和14d取大脑皮质,并每个时间点设未做任何干预对照组,用免疫印迹方法观察PRG-1蛋白表达.结果 末次惊厥后3 h,12h,48 h、14d大脑皮质可塑性相关基因-1的表达,对照组分别为1.363±0.742、1.278±0.687、0.763±0.374、1.004±0.113,实验组分为1.818±1.093、1.562±0.782、1.024±0.510、1.378±0.279.3 h、12h、48 h大脑皮质PRG-1的表达在实验组和对照组无统计学意义(t=0.843,0.668,1.011,均P＞0.05).14d大脑皮质PRG-1的表达,实验组明显高于对照组(t=3.041,P＜0.05).结论 PRG-1在新生大鼠反复长程惊厥后的远期表达增多,提示参与发育期惊厥性脑损伤的病理生理机制.     

新生儿枫糖尿症一例临床分析

病例：男,15天,因咳嗽、气促、反应差9天,昏迷8h入院。患儿系孕38周剖腹产,羊水清亮,出生体重3.2kg,无窒息史,发病前喂养正常。9天前患儿受凉后出现咳嗽,伴气促,哭声小,吃奶减少,反应差,嗜睡。立即到当地市级中心医院治疗,诊断为＂新生儿肺炎、败血症＂,给予抗感染、吸氧,补液纠酸等对症处理后,病情无好转。     

新生儿甲基丙二酸血症误诊一例分析

病例：男,7天,因皮肤黄染4天,反应差、发热3天,抽搐昏迷1天入院。患儿出生后第3天出现皮肤黄染。第4天患儿出现发热,反应差,嗜睡,进奶减少。立即到当地医院诊治,予抗感染等处理,病情无好转。